tbuckley/cabot-search huggingface dataset:
Abstract 9832: Liver-Heart Crosstalk Mediated by Coagulation Factor XI Protects Against Heart Failure
Authors: Yang Cao, Yuchen Wang, Zhenqi Zhou, Calvin Pan, Ling Jiang, Zhiqiang Zhou, Yonghong Meng, Sarada Charugundla, Tao Li, Hooman Allayee, Marcus Seldin, Aldons J Lusis
Journal: Circulation (2022)

Introduction: Tissue-tissue crosstalk by endocrine factors is a vital mechanism to maintain proper physiologic homeostasis. The heart and the liver display multifaceted interactions and it is common to observe heart diseases affecting the liver and vice versa. Hypothesis: We hypothesized that the liver-heart interactions may be mediated by novel endocrine factors. Methods: Global transcriptomic data from the heart and the liver were generated across all 100 diverse inbred strains of mice, the Hybrid Mouse Diversity Panel (HMDP), and used to detect the correlation structure between secreted proteins from the liver and their downstream effects on the heart. Candidates were validated in a “two-hit” model of heart failure with preserved ejection fraction (HFpEF) and plasma samples from HFpEF patients and controls were used to examine the clinical relevance. Results: Using the bioinformatics framework, we predicted that coagulation factor XI (FXI) is a liver-derived protein that influences heart gene expression and diastolic dysfunction, a key trait of HFpEF. In a mouse model of HFpEF, mice overexpressing FXI in the liver showed improved diastolic function and reduced inflammation and fibrosis, whereas FXI knockout mice were sensitized for diastolic dysfunction. FXI overexpression activated the bone morphogenetic protein (BMP)-Smad1/5 pathway in the heart, thus inhibiting genes involved in inflammation and fibrosis. The action of FXI on heart requires proteolytic activity, as point mutations in its catalytic domain eliminated effects on BMP signaling and heart function. BMP7 is secreted as an inactive precursor and our results indicate that it is cleaved by FXI, releasing the active dimer and monomer growth factor from the prodomain that binds to the extracellular matrix. Further, plasma FXI was inversely correlated with E/e’ ratio in all human participants and HFpEF patients. Conclusions: Our studies indicate that liver-derived FXI specifically regulates cardiomyocytes through the BMP-Smad1/5 pathway, resulting in attenuation of fibrosis, inflammation, and diastolic dysfunction in the context of a HFpEF model. Our study reveals a protective role of FXI on heart injury, distinct from its role in coagulation.
Abstract 9724: Left Atrial Volume Index as a Predictor of Atrial Fibrillation Recurrence After Cardioversion
Authors: Sittinun Thangjui, ratdanai yodsuwan, Harshith S Thyagaturu, Bishesh Shrestha, Tarun Bathini, Gayatri Bondi, Jerel Zoltick
Journal: Circulation (2022)

Introduction: The left atrial volume index (LAVI) is a standard measurement of the left atrium. To date, there is limited data on the risk of AF recurrence with different LAVI cut-point. We aim to determine the association of LAVI as a predictor of AF recurrence after external electrical cardioversion (ECV). Methods: We conducted a retrospective cohort study using data from a single tertiary care center from January 2013 to December 2019. Patients diagnosed with AF who underwent successful ECV were included with the final follow-up date of December 2020. The effect of LAVI on AF recurrence was determined by Cox regression analysis adjusted by age, sex, BMI, comorbidities, type of AF, ejection fraction, and medications. Results: A total of 296 patients, 61.8% male, with a mean age of 69.2 ± 11.2 years old were included with a mean follow-up time of 1 year. Antiarrhythmic drugs were used in 104 patients after the ECV. LAVI ≤ 34 ml/m2 is associated with a lower risk of AF recurrence with an adjusted hazard ratio (aHR) of 0.31 (95%CI: 0.20-0.40). LAVI &gt; 34 to &lt; 40 ml/m2, did not significantly increased the risk of AF recurrence (aHR 1.67, 95%CI: 0.97-2.87). LAVI of ≥ 40 ml/m2 and ≥ 50 ml/m2 significantly increased the risk of AF recurrence with aHR of 4.30 (95%CI: 2.61 - 7.10) and 4.97 (95%CI: 2.97 - 8.33), respectively. Conclusions: Normal LAVI is associated with a lower AF recurrence after ECV and LAVI ≥ 40 ml/m2 is associated with increased AF recurrence. LAVI is a predictor to consider before undergoing rhythm management in a patient with atrial fibrillation.
Abstract 9831: Antithrombotic Regimens After Transcatheter Aortic Valve Replacement: Comparison of Medium-Term Outcomes
Authors: Jwan A Naser, Benjamin R Gochanour, Christopher Scott, Austin M Kennedy, Sushil A Luis, Kevin Greason, Juan A Crestanello, Rajiv Gulati, Mackram F Eleid, Vuyisile T Nkomo, Sorin V Pislaru
Journal: Circulation (2022)

Introduction: Bioprosthetic valve thrombosis is a recognized cause of bioprosthetic valve dysfunction. It was found to be associated with accelerated bioprosthetic degeneration and higher rates of valve re-replacement. Hypothesis: Warfarin for 3 months after transcatheter aortic valve replacement (TAVR) protects against accelerated valve degeneration and is therefore associated with better outcomes compared to dual antiplatelet (DAPT) and single antiplatelet therapies (SAPT). Methods: Adult patients who underwent TAVR (2012-2019) were identified retrospectively (n=1,501). Patients with atrial fibrillation were excluded (n=657). Patients were classified into warfarin, DAPT, and SAPT groups based on antithrombotic regimen. Structural valve degeneration (SVD) was considered when patients developed new ≥ moderate trans-prosthetic regurgitation, increase in mean gradients ≥10 mmHg from baseline, or when gradients exceeded 20 mmHg. Discharge date was considered time zero. Results: Overall, 844 patients [mean age 80 (±9), 43% females, mean Society of Thoracic Surgeons risk score 6.7 (±5.0)] were included. Warfarin was used in 633 (75%) patients, DAPT in 164 (19%), and SAPT in 47 (6%). Median follow-up time was 2.5 (IQR 1.2-3.9) years. There was no difference in outcomes of ischemic stroke, death, valve re-intervention, SVD, their composite endpoint, or hemorrhagic stroke and hemorrhagic stroke/RBC transfusion events (Figures 1 &amp; 2), even after adjustment for confounders. Conclusion: Warfarin after TAVR was not associated with better clinical or hemodynamic outcomes or with worse adverse events compared to DAPT and SAPT.
Abstract 9874: Correlation of Left Ventricular Strain Derived From Rb-82 ECG-Gated PET Myocardial Perfusion Imaging vs 2D Echocardiography
Authors: Jingwen Huang, Adam Mitchell, Ernest Garcia, David Cooke, Russell Folks, Maria Pernetz, Marina Piccinelli, Jonathon Nye
Journal: Circulation (2022)

Introduction: Global longitudinal strain (GLS) by two-dimensional (2D) transthoracic echocardiography (TTE) is a robust index for identifying early left ventricular (LV) myocardial dysfunction. Positron emission tomography (PET) myocardial perfusion imaging (MPI) is widely used in the assessment of ischemic heart disease (IHD) but has not been used for strain analysis. Hypothesis: Longitudinal, radial, and circumferential myocardial strain measures at rest and at pharmacologic stress by Rb-82 ECG-gated PET MPI are correlated to those measured by resting 2D TTE. Methods: We developed a novel PET MPI method to track the LV myocardium throughout the cardiac cycle processed in the Emory Cardiac Toolbox, to measure LV strain from longitudinal, radial, and circumferential direction at regadenoson-stress and at rest. We retrospectively identified 80 patients who underwent Rb-82 PET MPI and also had TTE with strain analysis within 3 months. The agreement between LV strain and LVEF derived from PET MPI and resting TTE was assessed with Bland-Altman analysis, Pearson’s correlation, and the concordance correlation coefficient (CCC). Results: PET MPI derived measurements of longitudinal (Figure 1A-1B: Bland-Altman analysis; 1C-1D: Pearson’s correlations), circumferential (Figure 1E-1F: Pearson’s correlations) and radial (Figure 1G-1H: Pearson’s correlations) strain measures at rest and stress were strongly correlated to resting TTE derived GLS (p&lt;.001). LVEF showed strong correlations at stress (0.83, p&lt;.001) and rest (0.80, p&lt;.001). Inter-observer agreements of PET MPI strain measures showed high correlation between 2 independent observers for all 3 directions (p&lt;.001). Conclusions: LV strain measures by PET MPI using a novel automated technique correlated strongly with GLS by TTE. PET MPI measures are highly reproducible. Strain by PET MPI should be investigated further to establish its value in routine clinical practice.
Abstract 9705: Diastolic Blood Pressure and Intensive Blood Pressure Control on Cognitive Outcomes: Insights From the SPRINT Trial
Authors: Sitong Li, Chao Jiang, Yufeng Wang, Yiwei Lai, liu HE, Chen-Xi Jiang, Ribo Tang, Caihua Sang, Deyong Long, Xin Du, jz Dong, Changsheng Ma
Journal: Circulation (2022)

Introduction: The potential benefits or harms of intensive systolic blood pressure (SBP) lowering on cognitive function in individuals with low diastolic blood pressure (DBP) remain unclear. Hypothesis: The effects of intensive SBP lowering on cognitive outcomes were consistent across baseline DBP levels. Methods: In this post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), 8563 participants with at least one follow-up cognitive assessment were included. Cognitive outcomes were the occurrence of probable dementia, mild cognitive impairment (MCI), and a composite of probable dementia or MCI. Cox regression models and likelihood ratio tests were used to assess the interaction between DBP quartiles and intensive SBP control on cognitive outcomes. Results: The incidence rates of cognitive outcomes among participants in the lowest DBP quartile were higher than those in the other three DBP quartiles (Figure 1). However, participants in the intensive group had a lower incidence rate of probable dementia or MCI than those in the standard group, regardless of DBP quartiles. There were no significant interactions between SBP intervention and DBP quartiles for probable dementia ( P for interaction =0.06), MCI ( P for interaction =0.80), or a composite of probable dementia or MCI ( P for interaction =0.24) (Figure 2). Conclusions: In this post hoc analysis of the SPRINT study, patients with lower DBP had a higher incidence of cognitive impairment. However, the effects of intensive SBP lowering on cognitive outcomes were consistent across different DBP groups.
Abstract 9881: Effects of CPAP on Very Short-Term Blood Pressure Variability Associated With Sleep-Disordered Breathing Determined by Pulse-Transit-Time-Based Blood Pressure Measurements
Authors: Tomofumi Misaka, Akiomi Yoshihisa, Himika Ohara, Yukiko Sugawara, Yusuke Tomita, Tani Tetsuya, Shohei Ichimura, Yu Sato, Tetsuro Yokokawa, Satoshi Abe, Takamasa Sato, Takashi Kaneshiro, Masayoshi Oikawa, ATSUSHI KOBAYASHI, Yasuchika Takeishi
Journal: Circulation (2022)

Background: Sleep-disordered breathing (SDB) and blood pressure (BP) variability are closely associated with cardiovascular diseases. We have recently reported that pulse-transit-time (PTT) has enabled to monitor the beat-to-beat BP, identifying a strong relationship between the severity of SDB and the extent to very short-term BP variability. Here, we investigated the effects of continuous positive airway pressure (CPAP) on very short-term BP variability. Methods: We studied 57 patients (mean age 61 years old, male 42) with SDB who underwent the full polysomnography on two consecutive days for diagnosis (baseline) and CPAP. PTT was continuously monitored together, and PTT-based BP values were measured on a beat-to-beat basis. PTT index was defined as the average number of acute transient rises in BP (≥12 mmHg) within 30 seconds per hour. Results: Apnea-hypopnea index (AHI) was decreased from 46.5±22.4 to 13.7±15.0 (P&lt;0.01) by CPAP. CPAP significantly lowered the average value of systolic PTT-based BP from 121±21 to 118±20 mmHg (P=0.04). Importantly, CPAP significantly reduced the PTT index from 31.4±20.1 to 20.8±15.6 (P&lt;0.01) as well as the standard deviation (SD) of systolic PTT-BP from 5.3±1.9 to 4.9±1.4 mmHg (P=0.01), suggesting that very short-term BP variability was improved by CPAP ( Figure ). The changes in PTT index after CPAP were significantly correlated with the improvement in AHI (R=0.55), oxygen desaturation index (R=0.36), minimal SpO 2 (R=0.48), mean SpO 2 (R=0.46), and arousal index (R=0.58). In multivariate linear regression analysis, the change in AHI was the independent factor to determine the reduction of the PTT index after CPAP. Conclusion: PTT-based BP discovered the improvement in very short-term BP variability associated with SDB events by CPAP therapy.
Abstract 9931: Women Representation in Authorship of European Society of Cardiology Guidelines: Temporal Trends and a Geographic Perspective
Authors: Zainab A Dakhil, Aaysha Cader
Journal: Circulation (2022)

Introduction: Diversity of authors of the international Clinical Practice Guidelines (CPG) will ensure raising broader concerns and contributing different perspectives. There is lack of data regarding gender and global distribution of authors of cardiovascular CPG. Purpose: To assess gender and geographic distribution of authors of ESC CPG and compare these over the contemporary years (2015 - 2021) vs earlier years (prior to 2015). Methods: ESC website was searched to include CPG. Sex and affiliating country of authors were determined by searching ESC 365 platform, Google Scholar, ResearchGate, LinkedIn platforms, social media or author’s affiliating institution website. Results: Thirty-eight documents were analyzed (26 contemporary documents vs 12 earlier documents). The documents included 28 CPG and 10 non-CPG documents (i.e., position papers, expert consensus, scientific statements, or task force reports). Total number of authors =748, 18.85% were women (21.84% in contemporary documents vs 8.02% in earlier documents, p&lt;0.001). Total number of chair/co-chair position was 67, 10.44% were women (11.32% in contemporary vs 7.14% in earlier documents, p&lt;0.001). Lowest proportion of women authors was in interventional cardiology CPG (13.3%) while highest proportion was in pediatric cardiology CPG (37.5%). Highest proportion of total authors (regardless gender) was from UK, Italy and Germany in 11.9%, 11.1%, and 10.3% respectively. Highest number of women authors were from UK, Netherlands and Italy in 15.5%, 12.7% and 11.3% respectively. Highest percentage of women authors among total authors from each specific country were from Austria 46.7%, Netherlands 37.5% and Sweden 35.1% Conclusion: Despite trends showing an overall increase in female authorship over years, there still remain gender and geographic disparities in writing committee/ task force shares, indicating potential for enhanced efforts to improve diversity within professional societies.
Abstract 9747: Gastrointestinal Bleeding in Acute Myocardial Infarction Patients Undergoing Coronary Artery Bypass Graft Surgery; A National Study
Authors: Renuka Verma, Nomesh Kumar, Kamleshun Ramphul, Yogeshwaree Ramphul, Komal Kumari, Shaheen Sombans, Stephanie G Mejias, Syed Rashid Ali, Petras Lohana, Fnu Arti
Journal: Circulation (2022)

Introduction: While gastrointestinal (GI) bleeding is a possible surgical complication, there is a paucity of information on the incidence and risk among Acute Myocardial Infarction (AMI) patients undergoing Coronary artery bypass graft surgery (CABG). Methods: We queried the 2019 National Inpatient Sample to identify cases of GI bleeding among AMI patients undergoing CABG. Patient characteristics and risk factors were estimated using multiple logistic regression. Results: Our analysis found that 48590 patients with AMI underwent CABG, and 865 (1.8%) gastrointestinal bleeding events were recorded. It was more prevalent among Whites (aOR 1.462, p=0.012) and Hispanics (aOR 2.436, p&lt;0.01), patients of ages &gt;60 (aOR 1.591, p&lt;0.01), with a diagnosis of supraventricular tachycardia (aOR 1.688, p&lt;0.01), paroxysmal atrial fibrillation (aOR 1.670, p&lt;0.01), cirrhosis (aOR 3.363, p&lt;0.01), acute kidney injury (aOR 1.864, p&lt;0.01), covered by Medicare (aOR 1.494, p=0.010), and with peripheral vascular disease (aOR 1.731, p&lt;0.01). Meanwhile, patients with hypertension (aOR 0.573, p&lt;0.01), smokers (aOR 0.744, p&lt;0.01), hyperlipidemia (aOR 0.477, p&lt;0.01), and obesity (aOR0.799, p&lt;0.01) reported lower risks. A mortality rate of 12.7% was observed. Females (aOR 1.967, p=0.017), cirrhosis (aOR 5.521, p&lt;0.01), acute kidney injury (aOR 3.657, p&lt;0.01), ventricular tachycardia (aOR 2.002, p=0.033), paroxysmal atrial fibrillation (aOR 2.535, p&lt;0.01), and hyperkalemia (aOR 2.397, p=0.013) predisposed to greater inpatient deaths, while diabetes (aOR 0. 491, p&lt;0.01) and hyperlipidemia (aOR 0. 198, p&lt;0.01) showed a reduced risk. Finally, a higher overall risk of inpatient death was seen among AMI patients who underwent CABG if they had GI bleeding (aOR 2.674, p&lt;0.01). Conclusions: GI bleeding can lead to a poor outcome among AMI patients who underwent CABG during their hospitalization. We also found several factors predisposing these patients to such events.
Abstract 9840: A Rare Etiology of Diffuse Coronary Aneurysms
Authors: Christopher Lee, Vincent E Gacad, Sam D Dow, alan opsahl, Todd F Dombrowski, John Jayne, Stanislav Henkin
Journal: Circulation (2022)

Case: A 50-year-old woman with a prior right carotid aneurysm repair presented for chest pain. An evaluation 13 years ago showed a normal echo and cardiac catheterization. Four years prior, an echo showed an enlarged left ventricle with ejection fraction 57% and mid-anterolateral and inferolateral wall hypokinesis. Coronary angiography showed diffuse aneurysms of all coronary arteries with a proximal stenosis of the LAD, followed by a giant coronary aneurysm (Figure 1). CT angiography revealed bilateral intercostal artery aneurysms and a mildly ectatic aorta. She underwent bypass of the LAD with the LIMA. Aortic biopsy revealed no aortitis and prior carotid aneurysm pathology showed plasmalymphocytic inflammation; labs showed hypereosinophilia and elevated inflammatory markers with other negative immunologic work-up. She was diagnosed with hypereosinophilic vasculitis without evidence of granulomatosis and started on immunosuppressants.Due to symptoms, she underwent coronary angiography. Her LAD was occluded ostially with distal flow via a patent LIMA (Figure 2). There was progression of her aneurysmal disease at her proximal right coronary artery. No intervention was recommended. Instead, to improve control of her vasculitis, a Janus kinase inhibitor will be started. Discussion: Hypereosinophilic vasculitis, a variant of eosinophilic granulomatosis with polyangiitis, affects small- and medium-sized arteries and is challenging to diagnose. This case highlights a rare cardiac complication that can occur with this condition. Cardiac involvement often manifests as heart failure, pericarditis, valvular insufficiency, or rarely, coronary aneurysms.
Abstract 322: Impact Of Safety Net Hospital Burden On Outcomes Of In-hospital Cardiac Arrest In The United States.
Authors: Titilope Olanipekun, Temidayo Abe, Abimbola Chris-Olaiya, Valery S Effoe, Abhishek Bhardwaj, Michael F Harrison, Pablo Moreno Franco, Pramod Guru, Devang Sanghavi
Journal: Circulation (2022)

Background: Safety net hospitals treat a large burden of uninsured, or Medicaid insured patients, and have been linked to worse outcomes across several medical and surgical conditions. Currently, there is limited data on the effect of safety net burden on outcomes of inpatient cardiopulmonary resuscitation (CPR) for patients that suffered in-hospital cardiac arrest (IHCA) in the US. Hypothesis: Patients that experience IHCA in high burden safety net hospitals (HBH) will have worse outcomes compared to low burden safety net hospitals (LBH). Methods: Using the National Inpatient Sample database, from 2008 – 2018, we identified patients aged ≥ 18 years who experienced IHCA, using International Classification of Diseases (ICD) codes. Hospitals’ safety net burden was calculated from the proportions of Medicaid and uninsured patients using previously published methodology and categorized into LBH and HBH. Multivariate regression models were used to estimate the odds of key clinical outcomes Result: From 2008 to 2018, an estimated 555,016 unweighted adult hospitalizations underwent CPR for IHCA, out of which 19.2 % occurred at LBH and 55.2 % occurred at HBH. Compared with LBH, patients at HBH on average were younger 62 years ± 20 vs 67 years ± 17), less likely to be of White race, and more likely to be in the lowest median household income. On multivariate regression analysis, HBH was associated with lower chances of survival to hospital discharge (aOR 0.88; 95% CI 0.85 – 0.96) and lower odds of routine discharge (aOR 0.6; 95% CI 0.47 – 0.75)), compared to LBH. Patients who suffered IHCA in safety net hospitals with medium and large hospital bed size (aOR 0.96; 95% CI 0.94 – 0.98) and those publicly owned (aOR 0.95; 95% CI 0.92 – 0.98) were less likely to survive to hospital discharge. Median household income of patients in the 26 th – 100 th quartile and hospital location in the Midwest and Southern region were associated with better odds of hospital survival. Conclusion: Our study suggests that patients who experience IHCA at HBH had lower rates and odds of in-hospital survival and also less likely to be routinely discharged home. Patients’ income level and hospital-level characteristics appear to contribute to survival.
Abstract 293: Swedish Emergency Medical Dispatch Centres Ability To Answer And Manage Out Of Hospital Cardiac Arrest Calls In Accordance With The American Heart Association Performance Goals
Authors: Fredrik Byrsell, Andreas Claesson, Martin Jonsson, Mattias Ringh, Leif Svensson, Per Nordberg, Sune Forsberg, Jacob Hollenberg, Anette Nord
Journal: Circulation (2022)

Background: In witnessed OHCA each minute of delay to CPR reduce the probability of survival. Thus, Emergency Medical Dispatch Centres (EMDC) ability to rapidly answer the emergency call and dispatch EMS is crucial. The American Heart Association (AHA) states that the goal of public safety answering points in a high performing system is to answer OHCA calls within 10 seconds (s) and dispatch the first EMS unit within 60 s. Aim: The aim of the study was to 1) describe the EMDC call answer delay and 2) time to dispatch of the first EMS unit in OHCA calls in the region of Stockholm, during 10 years in accordance with the AHA goals for OHCA call handling. We also aimed to 3) investigate the effect of “late responders” on 30-day survival. Method: This is an observational study based on OHCA data from the region of Stockholm, Sweden, between year 2012 to 2021. Data was collected from the Swedish Registry for Cardiopulmonary Resuscitation (SRCR) and SOS Alarm AB database. Results: During the 10-year period, the EMDC answered a total of 12 298 calls with a corresponding OHCA-record in the SRCR. Complete data was available in 11 484 calls (93%) which were included in the analysis. Of these, 62% (n=7127) of OHCA calls were answered within 10 s, 20% (n=2306) in 10-20 s and 18% (n=2051) above 20 s. The median delay was 7.3 s [IQR 3.3, 15.1]. Dispatch of the first EMS unit was performed within 60 s in 9% (1053 of 11470), 23% (2640 of 11470) between 60-90 s and 68% (7777 of 11470) above 90 s, with a median delay of 114.5 s [IQR 81.4, 168.6]. Differences in call answer delay and time to dispatch of the first EMS unit over the 10-years are presented in Figure 1. Survival at 30-days was 11% (109 of 990) when EMS was dispatched within 60 s, 8.7% (215 of 2459) in 60-90 s and 10.3% (746 of 7210) above 90 s. Conclusion: In the region Stockholm the majority of emergency calls concerning OHCA were answered within the high performance system goal of 10 seconds. Additional effort is needed to achieve the 60 second goal for dispatch of the first EMS unit.